Communicating with Patients who don’t Speak Your Language

I’ve been working for just under two months now and one of the most striking differences between my cushy Western Cape training hospital and my current Eastern Cape job is that here, many more patients cannot communicate with me in a language we both understand.

I am bilingual, and in the Western Cape this has meant that I could communicate – either in Afrikaans or English – with probably around 90% of my patients. These days I probably speak an improvised fanagalo 90% of the day; so much so that I sometimes accidentally speak it to my colleagues and family!

That said, in Cape Town I sometimes had refugees as patients who could not understand a word I spoke, so it is not completely new to me. Here are some tips for when you and your patient don’t speak each other’s language, literally.

1. Learn to speak their language

Sounds simple but it isn’t. I’ve been trying to learn isiXhosa in earnest for six years, but it is hard. So far I know basic words, like colours, and the words for pain and numbness and… basic conversational stuff. Kind of like palpating the patient’s abdomen and saying, “Pain? Pain? Pain?” It is better than nothing, but learning an additional language properly should be number one on anyone’s list if you’re going to be working in a multicultural environment.

2. Use a translator

If you practise in the developed world, chances are your institution has a team of dedicated translators. If you work in a developing country… then you probably have only a few, if any. Make a point to find out if there IS a translator-service available and if so, what you have to do to make use of it.

3. If no official translator is available…

You may have to ask another healthcare worker to help out, or worst-case, the patient’s family member. This is undesirable for patient-confidentiality reasons (for example if you want to ask a patient their HIV-status but they have not disclosed it to their family), so you will have to tread carefully and be sensitive. Also remember that having to translate for a family member is also a burden on the ad-hoc translator. (You should totally read The Spirit Catches You And You Fall Down for more in this regard.)

4. …Or use technology

Google is great (I’m not sponsored I swear). If your patient is literate, you can have a semi-coherent conversation using the translate service. I once had a dress tailored in Vietnam by someone who did not understand a word of English. We had long and painful conversations using Google Translate, but it worked! In Japan everyone walks around with little pocket translators and that was great too.

5. Talk to the patient, not the translator

Make eye-contact with the patient. Your patient must know at all times that your dedication is to them, and they must not feel like a by-stander. Use personal pronouns, and adjust your body such that you are speaking directly to them, even though there is a translator involved.

6. Use short paragraphs

It doesn’t do to speak in single sentences because you’ll forget where you are and look stupid. Instead, organise your thoughts into short paragraphs, long enough to complete an idea, but short enough for the translator to remember everything.

7. Avoid flowery language

Metaphors that work in your language may be completely foreign to your patient. Especially if you are using an ad hoc translator, you might be working with someone whose English is only marginally better than the patient in question. To that end, be on the lookout for signs that your translator is confused!

8. But don’t dumb it down

Your patient speaks a different language, not no language at all. They will pick up on it if you are speaking to them like a child and that does not enrich the patient-provider relationship.

9. If an answer confuses you…

…ask your question in a different way.

10. ATTITUDE!

As with most of medicine (and LIFE) attitude is everything. If you are going to be miserable and annoyed because your patient does not speak your language (remember, you do not speak theirs either!) then the whole experience is going to suck. Enjoy the opportunity to be creative, to test your limits, and maybe even to learn a few more words.

Or people who have Aphasia of speech like I do and the inability to articulate on command some times, We have cops out there without attention to detail too busy trying to establish control that they miss something important like speech or language issues.

You’re reminding me now that I really need to take serious steps to learn Sesotho. Counselling in a multi-cultural environment is even more tricky than medical care, cause you really don’t want to use a translator if someone is sharing their most intimate thoughts and emotional and spiritual needs with you.

Absolutely. It’s a real problem in psychiatry as well, so much so that being fluent in an African language now gives a candidate a real advantage when they apply to the discipline. Same with counselling – and even if a person CAN speak your language, I always feel they appreciate it so much more when they can be counselled in their home language. Good luck – let me know if you find a good teacher!

I know how it must feel like, language barrier makes it difficult to diagnose & treat patients. Translators? We had one in the local clinic I volunteered in but they would use staff nurses most of the time, and she didn’t know as much English herself.

It’s really difficult and it causes the human/artistic element of the profession to suffer. Without human contact medicine is just science, and without communication the human contact is rather strenuous. Was this a volunteer clinic in China? Would love to hear more 🙂

Trying to communicate with patients in Kenya on my last elective was a huge challenge because I knew virtually no Swahili and most of them knew virtually no English. Luckily I had fellow healthcare workers to translate, but oftentimes that meant they would just take the history and not let me do anything haha.